Why Does Your Heartburn Always Seem Worse at Night?

Tips for reducing nocturnal heartburn

Why Does Your Heartburn Always Seem Worse at Night?

If you suffer from heartburn, you know that burning sensation in your chest is always unpleasant. But you may wonder why it often seems worse when you’re trying to get some sleep. Why is it more likely to flare up at night?

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Blame it on the natural force of gravity. It doesn’t work in your favor when you’re lying down.

When you sit or stand, gravity helps move your food through the esophagus and into the stomach where digestion occurs.

“But when you are lying down, you lose gravity’s help in allowing your esophagus to clear food, bile and acids. And that can allow for heartburn to happen,” says gastroenterologist Scott Gabbard, MD.

While every person’s experience with heartburn is a little different, most people have heartburn symptoms during the day and at night, he says. But many find it tougher to control at night.

What causes this burning sensation?

When you eat, food passes down your throat and through your esophagus to your stomach. A muscle (the lower esophageal sphincter) controls the opening between the esophagus and the stomach. It remains tightly closed except when you swallow food.

But when this muscle fails to close after food passes through, the acidic contents of your stomach can travel back up into the esophagus. Doctors refer to this backward movement as reflux.

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When stomach acid hits the lower part of the esophagus, it can produce a burning sensation. This is what we call heartburn or, more formally, gastroesophageal reflux disease (GERD).

About one in 10 adults has heartburn at least once a week, and one in three have it every month, Dr. Gabbard says. He estimates that 10 to 20 percent of adults have chronic heartburn.

A body pillow that works with gravity

In the past, Dr. Gabbard often advised patients to elevate the head of their bed with bricks or use a wedge-shaped pillow. However, patients saw mixed results, he says.

Now he recommends using a body pillow or sleep-positioning device that helps keep you on your left side with your head elevated.

Lying on your left side allows acidic contents to pass through the lower esophageal sphincter into the stomach. And elevating your head allows gravity to work.

“We get a 2-for-1,” says Dr. Gabbard.

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He has led studies to test the effectiveness of the pillows. In a study of patients who had nighttime heartburn despite acid-reducing drugs, the severity of nighttime heartburn was reduced by almost 70 percent after using the pillow.

For some, the acid reflux was so serious that they were considering surgery. Most opted not to have surgery after using the pillow, he says.

The pillow is available online without a prescription. People generally experience less heartburn within two weeks. But full improvement takes four to six weeks, he says.

Tips to reduce nighttime heartburn

There are other steps you can take to reduce heartburn. Dr. Gabbard offers these tips:

  • Lose weight. Body mass index (BMI) takes weight and height into account. People who are overweight (BMI of 25 or above) are at a greater risk for heartburn.
  • Stop smoking. Research suggests that if you can quit smoking, it will help, Dr. Gabbard says.
  • Eat smaller, less fatty meals, especially later in the day. For someone with chronic heartburn, a meal of less than 500 calories and 20 grams of fat is ideal, he says.
  • Wait at least three hours after eating to go to bed. “It takes the stomach four to five hours to fully empty a meal, so give it at least three hours,” he says.
  • Try acid-reducing medications. The most commonly prescribed medications for GERD are proton pump inhibitors. While thought to be generally safe, patients with long-term use of these medications should discuss potential risks with their physicians, Dr. Gabbard says.

While many people complain that spicy foods aggravate their heartburn, Dr. Gabbard says studies don’t support that claim. That said, he advises patients to keep their food sensitivities in mind and avoid foods that may trigger digestive problems for them.

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